Heart failure is a widespread condition in the population. It is considered the most frequent single diagnosis for hospital admission in Germany - and the trend is rising. Therefore, the term "epidemic" is appropriate when we talk about the disease, according to Prof. Dr. Lars Maier, conference president of the 89th annual gathering of the German Society of Cardiology 2023 (German acronym: DGK).
This circumstance is mainly due to two developments: On the one hand, thanks to medical advances, cardiovascular diseases such as myocardial infarction are surviving more and more frequently nowadays. But the development of heart failure, however, is favoured by the consequential damage left behind by these diseases. On the other hand, demographic change plays a major role. The risk of developing heart failure increases considerably from the age of 65. In summary: The more members of the population reach this age, the greater the number of patients who develop heart failure.
On the other hand, it is a positive trend that the mortality rate in cardiology has continuously decreased in recent years due to modern drug therapies and interventional treatment methods, for example in coronary heart disease. Through findings from basic science and clinical studies, many disease-causing mechanisms of the heart have become better understood in the past decades. The realisation, for example, that a high heart rate in heart failure does not lead to the heart contracting better, and thus being able to pump more blood into the circulation, led to the development of beta-blockers in the 1990s - today one of the most frequently prescribed drugs in Germany.
But what about the medical hopefuls in terms of heart failure? Here, Prof. Maier mentions SGLT2 inhibitors in particular - actually developed specifically for the treatment of diabetes. Prognosis and frequency of hospital admissions could be dramatically improved by these inhibitors in all forms of heart failure. The latest findings also showed that they have an effect on the sodium balance and consequently on the calcium balance of the heart muscle cells, which is crucial for the contraction force. In addition, a highly innovative approach by a research group from Hanover, Germany, is already being clinically tested within the framework of a phase II study, in which micro-RNA 132 is inhibited in order to directly strengthen cardiac function after a heart attack.
According to Prof. Maier, heart failure should never be considered in isolation, but also as a consequence of other diseases. If, for example, high blood pressure or diabetes were better controlled, this would also have a positive effect on the prevalence of heart failure.
However, the physician insists that everyone should learn and practice personal responsibility for prevention at an early age. Not only drug treatment is important, but also conscious nutrition and regular exercise play a very important role.
Of course, cardiology also has to deal with economic factors and staff shortages. On the one hand, many patients often have to be treated in a short time, on the other hand, there is a shortage of staff both in terms of doctors and nursing staff. New concepts are therefore urgently needed. Prof. Meier sees the profession of physician assistant as a good approach: this is a new course of study with a practical component that represents a kind of middle ground between nurses and physicians. Under supervision, certain physician activities could be taken over, PAs could also be deployed for borderline areas in medical treatment - for example in echocardiography or in the catheter laboratory - which could relieve physicians and nurses alike.
In summary, two opposing trends can be observed in heart failure: On the one hand, treatment is improving, but on the other hand, the number of patients suffering from heart failure will increase significantly in the future. In any case, it is certain that heart failure will remain the greatest challenge in cardiology for the next few years or even decades, and will continue to be the main reason for admission to German hospitals.
Drug therapies provide ever better therapeutic approaches, but self-responsible prevention is also important in order to put a stop to various disease patterns and consequently also to heart failure. Patients should always be healed as a whole, approaches such as the profession of physician assistant could contribute to patients being better cared for and physicians also being able to care for them more on a human level again.
L. S. Maier (Regensburg): "Heart Failure Epidemic - Exploring Mechanisms, Healing Hearts". (Original lecture title: "Herzinsuffizienz-Epedemie – Mechanismen erforschen, Herzen heilen"); 89th Annual Meeting for the German Society of Cardiology (German acronym: DGK). 12th April 2023.(Ravel Press Conference Hall) 11:30-12:30